Provider Demographics
NPI:1104020114
Name:SIMON, DANIEL JOSEPH (DMD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:JOSEPH
Last Name:SIMON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 THREE SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-7528
Mailing Address - Country:US
Mailing Address - Phone:270-782-5115
Mailing Address - Fax:270-782-5114
Practice Address - Street 1:625 THREE SPRINGS RD
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-7528
Practice Address - Country:US
Practice Address - Phone:270-782-5115
Practice Address - Fax:270-782-5114
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY8457122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist